Zhu PA, Xie JY, Liu H, et al. Efficacy of High-Frequency Repetitive Transcranial Magnetic Stimulation at 10 Hz in Fibromyalgia: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022 May 27. pii: S0003-9993(22)00413-0. doi: 10.1016/j.apmr.2022.05.006. (Systematic review)

OBJECTIVE: The purpose of this review was to systematically assess the effectiveness of 10-Hz repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia.

DATA SOURCES: We searched PubMed, Cochrane Library, Embase, Web of Science, and Ovid databases as of November 6, 2021.

STUDY SELECTION: The inclusion criteria for this review were randomized controlled trials of 10-Hz rTMS for fibromyalgia, exploring the effects of 10-Hz rTMS on pain, depression, and quality of life in patients with fibromyalgia.

DATA EXTRACTION: Data extraction was performed independently by 2 evaluators according to predefined criteria, and the quality of the included literature was assessed using the Cochrane Bias Risk Assessment Tool. The measurement outcomes include visual analog scale, Hamilton Depression Rating Scale, and Fibromyalgia Impact Questionnaire, and so on.

DATA SYNTHESIS: A total of 488 articles were screened, and the final 7 selected high-quality articles with 217 patients met our inclusion criteria. Analysis of the results showed that high-frequency transcranial magnetic stimulation at 10 Hz was significantly associated with reduced pain compared with sham stimulation in controls (standardized mean difference [SMD]=-0.72; 95% confidence interval [CI], -1.12 to -0.33; P<.001; I2=46%) and was able to improve quality of life (SMD=-0.70; 95% CI, -1.00 to -0.40; P<.001; I2=15%) but not improve depression (SMD=-0.23; 95% CI, -0.50 to 0.05; P=.11; I2=33%). In addition, a subgroup analysis of pain conducted based on stimulation at the primary motor cortex and dorsolateral prefrontal cortex showed no significant difference (SMD=-0.72; 95% CI, -1.12 to -0.33; P=.10; I2=62%).

CONCLUSIONS: Overall, 10-Hz rTMS has a significant effect on analgesia and improved quality of life in patients with FMS but did not improve depression.

Discipline Area Score
Physician 5 / 7
Rehab Clinician (OT/PT) 5 / 7
Psychologist 5 / 7
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Comments from MORE raters

Physician rater

7 small studies included in meta-analysis showing benefit for pain and QoL for TMS in fibromyalgia. This is sufficient preliminary evidence to justify a large RCT to clarify, but not sufficient to adopt in practice.

Psychologist rater

As a psychologist, I am very familiar with 3rd generation behavioural intervention for this problem. This article is of limited utility.

Psychologist rater

Interesting article and suggestive of benefit. As the authors point out, however, the sample size is relatively small, and many questions remain unanswered about the frequency, location, and patient selection before this moves into mainstream clinical practice.

Rehab Clinician (OT/PT) rater

This is useful work. There is a good introduction.
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